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I <br /> APPLICATION FOR CONST6JCTION <br /> PERMIT <br /> i <br /> the Evergreen r <br /> CITY OF We <br /> everett <br /> BUILDING DEPARTMENT <br /> 259.8810 TO BE COMPLETED IN INK— PLEASE PP.INT <br /> OWNER MAIL ADDRESS CITY ZIP PHONE <br /> �r�;g /l�Q � �. 7� •-� sEyw `7'SZC.3 353-2§2q <br /> TZN�{!T-TT-"" MAIL ADORES CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> • TRACTOR / MAIL ADDRESS CITY 11P PHONE LIC"SE i� <br /> AAL) /l 1rtJ1 p ,. "?)Ib mffAV �yti+�Ln/� U/ 2tS-SSS'(-//Ay�.'•Lk�J <br /> ECHANICA CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br /> CLASSOF WORK <br /> o SSNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDINORELOCATON <br /> TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY CONTACT PERSON AND PHONE NO <br /> CONTRACT PRICE OF WORK 2=0� _ <br /> DESCRIBE WORK AND BOUARE FOOTAIJE INVOLVED <br /> r <br /> PROPOSED LOSE u DING 1HEREBYC.ERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> LE AL DEBCRIPTION�LiIi PEIO�PY IY�IBHOWN BELOW OR ATTACH iOURCOPIE81 ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH I <br /> WHETHER FPECIFIED HFRE•I•I OR NOT.YHF GRANTING OFA PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> BLOCK OF — - ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br /> FC RMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> 298.200 WAC <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> X <br /> _A PROJECT ADDRESS ���• A PLICA YBUSIN SSL( NDBUBI NAM ' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—AlHNDLO UNITS—H P _ <br /> BATHTUB FORCED AIR SYSTEMS—BT.U. MEA _ <br /> LAVATORY(WASH BASIN) UNIT HEATERS—BT.U. M <br /> f SHOWER CLOTHESDRYERS <br /> t KITCHEN SINK DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> pP CLOTHES WASHER WOOD STOVE <br /> e URINAL METAL FIREPLACE B CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAI NLEADERS EXHAUST FAN i <br /> SINK(SERVICE—BAR,ETC) <br /> ,I <br /> SUBTOTAL S SUBTOTAL t —' <br /> PERMIT 6 PERMIT III <br /> TOTAL FEE f TOTAL FEE i <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK RAN CHECK NUMBER FEE MICRO"NO. <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION PER <br /> O YES CI NO <br /> BUILDING <br /> TYPE OF CONST OCCUPANCYGROUP NO OF DWELLING UNITS <br /> ALLOWARI EIACTUAL PLUMBING <br /> SIZE OF BLDG NO OF STORIES OEMT. OCC LOAD <br /> o Y MECHANICAL <br /> ON <br /> HEIGHT LIMITATGN OTHER <br /> FIRE BPPINKLERB PEOUIPED OYES ❑NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPLICATION AOC BY PLANSAPPR BY <br /> PUBLIC WORKS I' <br /> TOTAL '�• <br />